Healthcare Provider Details

I. General information

NPI: 1760375919
Provider Name (Legal Business Name): SHANNON MARIE BAILEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 NATIONAL PKWY STE 20
SCHAUMBURG IL
60173-5150
US

IV. Provider business mailing address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-7890
  • Fax:
Mailing address:
  • Phone: 708-681-0073
  • Fax: 708-681-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178033323
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: